When you have ulcerative colitis (UC), it’s normal to have pain in your abdomen, along with diarrhea and other gastrointestinal (GI) symptoms.
Up to 30 percent of people with UC also have arthritis, which is characterized by swollen, painful joints.
Here’s a look at the connection between UC and joint pain, as well as what you can do to protect your joints if you have UC.
UC is a type of inflammatory bowel disease (IBD). Arthritis is the most common non-GI complication of IBD. The reason for the link may lie in genes that make people with IBD more susceptible to arthritis.
Two types of conditions can affect the joints of people with UC. Arthritis is joint pain with inflammation (swelling and redness). Arthralgia is pain in the joints without any inflammation.
Arthritis that occurs with UC is a bit different than regular arthritis. For one thing, it typically starts at a younger age.
In addition, arthritis in people with UC doesn’t usually cause long-term joint damage. The joints swell up and become painful, but they return to normal once intestinal inflammation is under control.
A few types of arthritis can affect people with UC:
Peripheral spondyloarthritis is a type of spondyloarthritis (SpA). Spondyloarthritis refers to a group of inflammatory conditions that affect the spine and other joints.
Peripheral spondyloarthritis affects large joints in the arms and legs, such as the:
The level of pain tends to mirror your UC symptoms. The more severe your UC, the more severe your arthritis symptoms will be. Once your bowel symptoms go away, your joint pain and swelling should go away as well.
Axial spondyloarthritis (axSpA)
Axial spondyloarthritis (axSpA) is a type of SpA that affects the lower spine and sacroiliac joints in the pelvis.
Symptoms can begin months or even years before a UC diagnosis. AxSpA can cause the bones of your spine to fuse together, limiting your movement.
Ankylosing spondylitis (AS)
Ankylosing spondylitis (AS) is a more severe form of axSpA. It can affect your flexibility by making your back stiff and forcing you into a bent-over posture. This type of arthritis doesn’t improve when you treat UC symptoms.
The treatment your doctor recommends will depend on the type of joint pain you have.
Medications to avoid
People usually control peripheral spondyloarthritis pain and swelling with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn).
These drugs can irritate the intestines and make inflammation worse, so they’re not usually a good option for people with UC.
Medications to try
Instead, your doctor might prescribe one of these UC drugs, which bring down inflammation in both the joints and intestines:
- steroids, such as prednisone
- disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine (Azulfidine) and methotrexate
- tofacitinib (Xeljanz), a unique oral medication that reduces inflammation in people with UC
- injectable biologics, such as adalimumab (Humira), golimumab (Simponi), infliximab (Remicade), and vedolizumab (Entyvio)
Tofacitinib is in a class of medications called Janus kinase (JAK) inhibitors. It’s also used to reduce inflammation in rheumatoid arthritis and psoriatic arthritis.
Biologic drugs also treat axSpA. If you have a more severe form of SpA, it’s important to stick with the treatment your doctor prescribes to prevent permanent joint damage.
If you have moderate to severe ulcerative colitis
In 2020, the American Gastroenterological Association (AGA) released updated treatment guidelines for adults with moderate to severe UC.
The AGA suggested that people who’ve never received biologics before should only receive tofacitinib if they’re a part of a clinical study or registry study.
The organization also recommended that people who’ve never received biologics before choose infliximab (Remicade) or vedolizumab (Entyvio) instead of adalimumab (Humira).
Adalimumab isn’t as effective as the other two biologics. However, people with UC can administer adalimumab to themselves, while healthcare professionals have to administer infliximab and vedolizumab. If you’re looking for convenience over efficacy, it’s fine to choose adalimumab instead.
In addition to taking medication, you can try managing your joint pain with these home remedies:
- Apply warm, wet compresses or a heating pad to achy joints.
- Stretch the affected joints and do range-of-motion exercises. A physical therapist can show you the correct techniques.
- Ice and elevate the inflamed or swollen joint.
Remember to speak with your doctor before trying any home remedies.
You’ll likely need the help of a rheumatologist to treat your joint pain. A rheumatologist is an arthritis specialist. The doctor will ask questions about your pain, such as:
- When did the joint pain start?
- What does it feel like?
- What makes it better or worse?
- Do you have swelling in the joints?
Keep a journal of your pain for a week or two ahead of time. This can help you prepare for your appointment. Also, create a list of questions that you’d like to ask your doctor.
Your doctor will perform some tests to find out whether you have arthritis or another condition that affects your joints. These tests can include:
- blood tests for markers of inflammation or genes that are common in people with IBD and arthritis
- a joint fluid analysis
- an MRI scan
Arthralgia and peripheral spondyloarthritis pain should usually go away once your GI symptoms are under control. For axSpA, you’ll need to take biologic drugs for control of inflammation, pain, and swelling.
Here are some things you can do that may help prevent joint pain:
- Take your medications exactly as your doctor prescribed, and don’t skip doses.
- Follow a balanced diet. Ask your doctor for guidelines if you need help planning nutritious meals.
- Avoid foods that aggravate your UC. This may include spicy, high-fiber, high-fat, or dairy foods.
- Practice relaxation techniques such as deep breathing to reduce your stress, which can trigger UC flare-ups.